Cand.med. Kristine Bech Holte at Institute of Clinical Medicine defended the thesis “Coronary artery disease and musculoskeletal complications in long-term survivors of type 1 diabetes: Associations with long-term glycation, oxidation and lipid markers” for the degree of PhD (Philosophiae Doctor). Principal supervisor was associate professor Tore Julsrud Berg.
Summary of the research
The subject of this thesis is coronary artery disease and musculoskeletal complications in long-term type 1 diabetes. Musculoskeletal complications are prevalent but an understudied complication of type 1 diabetes. The advent and continual improvement of CT coronary angiography (CTCA) has made it possible to noninvasively assess coronary atherosclerosis.
The aim of this thesis was to study the impact of living with type 1 diabetes for ≥ 45 years on the prevalence of coronary artery disease and musculoskeletal complications. Secondly, we aimed to find associations between biological markers such as measures of glycaemic burden, oxidation products and mean LDL-cholesterol with the presence of complications.
The Dialong study was a cross-sectional study conducted in 2015 including 105 persons with type 1 diabetes ≥ 45 years recruited from a single centre and 75 controls (spouses or friends) without diabetes. All participants without established coronary heart disease underwent CTCA and were interviewed and examined for the presence of musculoskeletal complications. We collected data from patient files and lab data from the previous 20-30 years and analysed skin collagen advanced glycation end-products (AGEs).
Twenty-four percent of persons with type 1 diabetes without established coronary heart disease had undiagnosed obstructive coronary artery disease, significantly higher than the controls, and 1 in 8 needed coronary intervention. All musculoskeletal complications were significantly higher in the diabetes group, including a lifetime prevalence of frozen shoulder of 76% compared to 14% in the control group.
The present study provides an important clinical message that there is a high prevalence of both undiagnosed obstructive coronary artery disease and musculoskeletal complications in long-term type 1 diabetes. It also adds evidence to support good glycaemic control and low LDL-levels over time and gives further evidence to the role of AGEs in diabetic complications.